Coverage and uptake of neutralising monoclonal antibodies or antivirals for non-hospitalised patients with COVID-19
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Overview
While vaccines remain the best strategy to prevent COVID-19, recent evidence suggests monoclonal antibodies (nMABs) or antivirals could potentially benefit certain vulnerable populations before or after exposure to SARS-CoV-2, such as the unvaccinated or recently vaccinated high-risk patients.
With the recent roll out of nMABs and antivirals, there is an urgent need to for knowledge and understanding around the use of nMABs and antivirals in the treatment of patients with COVID-19, such as factors of relevance in determining nMAB and antiviral treatment and the impact of nMAB and antiviral treatment in the community and hospital settings.
This OpenSAFELY report..
The code and data for this report can be found at the OpenSafely antibody-and-antiviral-deployment repository.
Results
Coverage of COVID-19 treatment
Between 11-Dec-2021 and 10-Feb-2022, a total of 47,700 non-hospitalised patients registered at a TPP practice in England were identified as being eligible for receiving a nMABs or antiviral for treating COVID-19 (Figure 1). Within the same time period, a total of 5,980 patients had received a nMABs or antiviral treatment for COVID-19 (Figure 2);
- Paxlovid: 20;
- Sotrovimab: 3,290;
- Remdesivir: 0;
- Molnupiravir: 2,610;
- Casirivimab: 50,
For all subsequent analysis by high risk cohort, patients identified as being eligible for receiving a nMABs or antiviral for treating COVID-19 have been included within each high risk cohorts that their records indicate they fall into. Out of the 47,700 eligible patients, 45,030 (94%) were included in two or more high risk cohorts (range 1 - 6).
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Figure 1: Cumulative total of patients eligible for receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort. Note, eligible patients can appear in more than one high risk group and the overall number (pre 10th February 2022) in each group is likely to be an overestimation due to including patients where their SARS-CoV-2 infection is confirmed by a lateral flow or polymerase chain reaction test.
Figure 2: Cumulative total of patients who received a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohorts. Note, treated patients can appear in more than one high risk group
Delivery of nMAB and antiviral treatment
Figure 3: Weekly proportion of eligible patients receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort and treatment type
| High risk cohort | Count | Count | % | Count (%) | Count (%) | Count (%) | Count (%) | Count (%) |
|---|---|---|---|---|---|---|---|---|
| All | 47700 | 5980 | 13 | 20 (0) | 3290 (55) | <5 | 2610 (44) | 50 (1) |
| Immune-mediated inflammatory disorders | 19200 | 2800 | 15 | 10 (0) | 1550 (55) | <5 | 1220 (44) | 20 (1) |
| Primary immune deficiencies | 9390 | 1120 | 12 | 10 (1) | 580 (52) | <5 | 530 (47) | 10 (1) |
| Solid cancer | 7810 | 900 | 12 | <5 | 510 (57) | <5 | 370 (41) | 10 (1) |
| Rare neurological conditions | 5340 | 860 | 16 | <5 | 440 (51) | <5 | 410 (48) | 10 (1) |
| Haematological diseases and stem cell transplant recipients | 3550 | 820 | 23 | <5 | 450 (55) | <5 | 360 (44) | 10 (1) |
| Solid organ transplant recipients | 3300 | 800 | 24 | <5 | 500 (62) | <5 | 290 (36) | 10 (1) |
| Renal disease | 2960 | 760 | 26 | <5 | 500 (66) | <5 | 260 (34) | 10 (1) |
| Liver disease | 2950 | 290 | 10 | <5 | 150 (52) | <5 | 140 (48) | <5 |
| Down’s syndrome | 1020 | 140 | 14 | <5 | 50 (36) | <5 | 90 (64) | <5 |
| Sickle cell disease | 730 | 50 | 7 | <5 | 20 (40) | <5 | 30 (60) | <5 |
| Immuosupression due to HIV or AIDS (CD4 <350 cells/mm3) | 320 | 190 | 59 | <5 | 70 (37) | <5 | 120 (63) | <5 |
Key demographic and clinical characteristics of treated patients
Table 2 shows the number and proportion of patients who had received treatment by 10-Feb-2022, broken down by demographic and clinical categories and treatment type.
| Group | Variable | Count | Count | % | Count (%) | Count (%) | Count (%) | Count (%) | Count (%) |
|---|---|---|---|---|---|---|---|---|---|
| Age band | 30-39 | 6140 | 920 | 15 | <5 | 530 (58) | <5 | 380 (41) | 10 (1) |
| Age band | 40-49 | 7960 | 1240 | 16 | 0 (0) | 710 (57) | <5 | 520 (42) | 10 (1) |
| Age band | 50-59 | 9480 | 1340 | 14 | 10 (1) | 760 (57) | <5 | 570 (43) | 10 (1) |
| Age band | 60-69 | 8140 | 1030 | 13 | <5 | 570 (55) | <5 | 440 (43) | 10 (1) |
| Age band | 70-79 | 6800 | 690 | 10 | <5 | 360 (52) | <5 | 320 (46) | <5 |
| Age band | 80+ | 4330 | 240 | 6 | <5 | 100 (42) | <5 | 140 (58) | <5 |
| Sex | Female | 26880 | 3490 | 13 | 10 (0) | 1960 (56) | <5 | 1500 (43) | 20 (1) |
| Sex | Male | 20820 | 2490 | 12 | 10 (0) | 1340 (54) | <5 | 1120 (45) | 30 (1) |
| Ethnicity | White | 38020 | 5050 | 13 | 20 (0) | 2810 (56) | <5 | 2180 (43) | 40 (1) |
| Ethnicity | Asian or Asian British | 2440 | 320 | 13 | <5 | 200 (62) | <5 | 120 (38) | <5 |
| Ethnicity | Black or Black British | 1960 | 180 | 9 | <5 | 90 (50) | <5 | 80 (44) | <5 |
| Ethnicity | Mixed | 640 | 80 | 12 | <5 | 40 (50) | <5 | 40 (50) | <5 |
| Ethnicity | Other ethnic groups | 780 | 90 | 12 | <5 | 40 (44) | <5 | 50 (56) | <5 |
| Ethnicity | Unknown | 3860 | 270 | 7 | <5 | 120 (44) | <5 | 150 (56) | <5 |
| IMD | 1 most deprived | 9800 | 860 | 9 | <5 | 480 (56) | <5 | 360 (42) | 10 (1) |
| IMD | 2 | 9460 | 1110 | 12 | <5 | 610 (55) | <5 | 490 (44) | 10 (1) |
| IMD | 3 | 9660 | 1330 | 14 | <5 | 720 (54) | <5 | 590 (44) | 10 (1) |
| IMD | 4 | 9070 | 1230 | 14 | <5 | 690 (56) | <5 | 530 (43) | 10 (1) |
| IMD | 5 least deprived | 8380 | 1270 | 15 | 10 (1) | 690 (54) | <5 | 570 (45) | 10 (1) |
| IMD | Unknown | 1330 | 180 | 14 | <5 | 100 (56) | <5 | 80 (44) | <5 |
| Rurality | Urban - conurbation | 13000 | 1280 | 10 | <5 | 710 (55) | <5 | 570 (45) | <5 |
| Rurality | Urban - city and town | 24440 | 3200 | 13 | 10 (0) | 1680 (52) | <5 | 1480 (46) | 30 (1) |
| Rurality | Rural - town and fringe | 5510 | 790 | 14 | <5 | 490 (62) | <5 | 300 (38) | 10 (1) |
| Rurality | Rural - village and dispersed | 3470 | 530 | 15 | <5 | 330 (62) | <5 | 190 (36) | 0 (0) |
| Rurality | Unknown | 1280 | 170 | 13 | <5 | 100 (59) | <5 | 80 (47) | <5 |
| Region | East Midlands | 8560 | 970 | 11 | 10 (1) | 680 (70) | <5 | 270 (28) | 20 (2) |
| Region | East of England | 11240 | 1890 | 17 | <5 | 1000 (53) | <5 | 860 (46) | 20 (1) |
| Region | London | 3050 | 400 | 13 | <5 | 160 (40) | <5 | 240 (60) | <5 |
| Region | North East | 2620 | 310 | 12 | <5 | 230 (74) | <5 | 80 (26) | <5 |
| Region | North West | 5100 | 560 | 11 | 10 (2) | 270 (48) | <5 | 290 (52) | <5 |
| Region | South East | 2930 | 380 | 13 | <5 | 210 (55) | <5 | 170 (45) | <5 |
| Region | South West | 5340 | 860 | 16 | 10 (1) | 400 (47) | <5 | 450 (52) | <5 |
| Region | West Midlands | 1970 | 230 | 12 | <5 | 180 (78) | <5 | 50 (22) | <5 |
| Region | Yorkshire and the Humber | 6820 | 370 | 5 | <5 | 170 (46) | <5 | 200 (54) | <5 |
| Region | Unknown | 60 | 10 | 17 | <5 | 0 (0) | <5 | <5 | <5 |
| Autism | Autism | 270 | 40 | 15 | <5 | 10 (25) | <5 | 20 (50) | <5 |
| Care home | Care home | 1560 | 60 | 4 | <5 | 10 (17) | <5 | 50 (83) | <5 |
| Dementia | Dementia | 1150 | 40 | 3 | <5 | 10 (25) | <5 | 30 (75) | <5 |
| Learning disability | Learning disability | 1220 | 150 | 12 | <5 | 60 (40) | <5 | 100 (67) | <5 |
| Serious mental illness | Serious mental illness | 640 | 70 | 11 | <5 | 30 (43) | <5 | 30 (43) | <5 |
| Housebound | Housebound | 1710 | 170 | 10 | <5 | 80 (47) | <5 | 80 (47) | <5 |
| CEV | CEV | 25190 | 4230 | 17 | 10 (0) | 2370 (56) | <5 | 1810 (43) | 40 (1) |
| Vaccination status | Un-vaccinated (declined) | 760 | 30 | 4 | <5 | 20 (67) | <5 | 10 (33) | <5 |
| Vaccination status | Un-vaccinated | 2230 | 110 | 5 | <5 | 50 (45) | <5 | 60 (55) | <5 |
| Vaccination status | One vaccination | 1520 | 120 | 8 | <5 | 60 (50) | <5 | 50 (42) | <5 |
| Vaccination status | Two vaccinations | 7200 | 510 | 7 | <5 | 270 (53) | <5 | 230 (45) | 10 (2) |
| Vaccination status | Three or more vaccinations | 36000 | 5210 | 14 | 10 (0) | 2890 (55) | <5 | 2270 (44) | 40 (1) |
Concordance with guidance
Of the 5980 patients who received treatment for COVID-19 between 11-Dec-2021 and 10-Feb-2022, 1,165 patients were missing records needed to confirm eligibility. It is likely that most, if not all, of these patients meet all of the eligibility criteria and non of the exclusion criteria but, for example, their SARS-CoV-2 test result is not available in their record or we just do not have access to all the criteria the clinician might use to assess high risk group status (such as the patients identified via non digital methods).
Figure 3: Breakdown of eligibility criteria variables in treated patients with missing records needed to confirm eligibility
